• Casey M Chai, Kenneth Seier, Kay See Tan, Iris Chu, James M Isbell, Gregory W Fischer, and Anoushka M Afonso.
• Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY.
• J. Cardiothorac. Vasc. Anesth. 2021 Feb 1; 35 (2): 571-577.

ObjectivesThe objective of this study was to describe practice patterns of anesthetic management during pericardial window creation.DesignRetrospective observational cohort study.SettingSingle tertiary cancer center.ParticipantsA total of 150 patients treated for cancer between 2011 and 2015 were included in the study.Measurements And Main ResultsThe primary objective was to evaluate anesthetic management in pericardial window creation. Secondary outcomes were 30-day mortality and overall survival after pericardial window creation. Thirty-day mortality was 19.3%, and median survival was 5.84 months. Higher American Society of Anesthesiologists (ASA) physical status of patients was associated with preinduction arterial line placement (51% ASA 3 v 79% ASA 4; p = 0.002) and use of etomidate for anesthetic induction (34% ASA 3 v 60% ASA 4; p = 0.003). However, there was no association between anesthetic management and presence of tamponade in these patients. Cardiac aspirate volume (per 10 mL: odds ratio [OR], 1.02 [95% CI, 1.0-1.04]; p = 0.026) and intraoperative arrhythmia (atrial fibrillation: OR, 6.76 [95% CI, 1.2-37.49]; p = 0.029; sinus tachycardia: OR, 4.59 [95% CI, 1.25-16.90]; p = 0.022) were associated independently with increased 30-day mortality. High initial heart rate (per 10 beats per minute: hazard ratio [HR], 1.18 [95% CI, 1.05-1.33]; p = 0.005) in the operating room and intraoperative sinus tachycardia (HR, 1.86 [95% CI, 1.15-3.03]; p = 0.012) were associated independently with worse overall survival.ConclusionRisk of death after pericardial window creation remains high in patients with cancer. Variations in anesthetic management did not affect survival in oncologic patients with pericardial effusions.Copyright © 2020 Elsevier Inc. All rights reserved.

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